Volume 24, Issue 2 (Summer 2018)                   IJPCP 2018, 24(2): 148-163 | Back to browse issues page


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Pourshahriar H, Alizade H, Rajaeinia K. Childhood Emotional Abuse and Borderline Personality Disorder Features: The Mediating Roles of Attachment Style and Emotion Regulation. IJPCP 2018; 24 (2) :148-163
URL: http://ijpcp.iums.ac.ir/article-1-2814-en.html
1- Department of Applied Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
2- Department of Clinical & Health Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran , E-mail: alizade72@yahoo.com
3- Department of Educational & Development Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
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Extended Abstract
1. Introduction

Borderline Personality Disorder (BPD) is a grave disorder accounting for 20% to 40% of psychiatric inpatient admissions [1]. It is estimated that 84% of patients with BPD show suicidal behaviors and 8% of them die by suicide [2]. BPD is a problematic situation in clinical populations, and the general population, because BPD features manifest a continuum. Adult BPD features in the general population result in significant adverse complications like academic failure, meeting lifetime criteria for a mood disorder, relationship problems, and alcohol use  [3]
Several studies have confirmed the relationship between childhood emotional abuse and BPD in adulthood [4]. For example, Bierer et al. [40] found that childhood emotional abuse-and not physical or sexual abuse, or any form of neglect was predicted by a BPD diagnosis. However, although many studies have confirmed the relationship between childhood emotional abuse and BPD, this does not mean that all victims of emotional abuse are affected by this disorder [6]. Thus, it is important to delineate the specific mechanisms accounting for this relationship. In this regard, a handful of studies have identified two major links between childhood abuse and BPD pathology. One link is attachment style and insecurity in attachment [7] and the other is difficulties with emotion regulation [8].
Several empirical researches have shown the theoretical relationship between attachment insecurity and BPD [7]. However, there is no research agreement about which attachment styles are involved in this relationship [7]. The other link between child abuse and BPD is difficulties in emotion regulation. Studies suggest that children with a history of childhood emotional abuse are more likely to have difficulties with emotion regulation [3]. Similarly, individuals with BPD diagnosis report having general difficulties with emotion regulation [41]
Thus, this study aims to investigate the relationship between childhood emotional abuse and BPD features. In this regard, researchers intend to examine the role of attachment styles and emotion regulation. In other words, the role of attachment styles and emotion regulation in the relationship between childhood emotional abuse and BPD features has been studied.
2. Method
Study participants

A total of 312 students were selected from the Shahid Beheshti University, Tehran. The sample included 128 (41.02%) male and 184 (58.98%) female, with age ranging from 18 to 31 years (M=22.9, SD=3.1). All participants gave their informed consent for this study.
Study measures 
Child Trauma Questionnaire (CTQ)

CTQ is a 45-item retrospective self-report questionnaire that assesses  subjectively participant’s general childhood environment  [10]. It covers five domains of childhood trauma, i.e., sexual abuse, emotional abuse, emotional neglect, physical abuse, and physical neglect. This study only employed the emotional abuse and emotional neglect subscales. The Persian version of CTQ showed a high internal consistency (Cronbach's α=0.65-0.91) and acceptable test-retest reliability [11].
Borderline Personality Inventory (BDI)
BDI is a 53-item self-report inventory, which is widely used for assessing borderline personality traits in clinical and nonclinical samples. Persian version of BDI showed acceptable test-retest reliability (r=0.80) and acceptable subscales reliability [12].
Difficulties in Emotion Regulation Scale (DERS)
DERS is a self-report questionnaire that assesses both individual’s overall difficulties in emotion regulation and their difficulties across six domains of emotion regulation. Persian version of this scale has a high internal consistency (Cronbach's α=0.86) [13].
Revised Adult Attachment Scale (RAAS)
RAAS is an 18-item self-report questionnaire which assesses three attachment styles: secure attachment, insecure anxious attachment, and insecure avoidant attachment. Cronbach's α of the Persian version for each of the three subscales are 0.81, 0.85 and 0.81, respectively, which are high. Also test-retest coefficient of this scale is acceptable (r=0.89) [14].
Data analysis
The present study is a correlational study and its data were processed by Structural Equation Modeling (SEM) or causal modeling using path analysis. 
3. Results
Table 1 demonstrates matrix of correlations between variables of the study. According to Table 1, as the direct path of emotional abuse and BPD was not significantly correlated, hence this path was removed in the final model and the measurement model was again evaluated. Fit indices (Table 2) demonstrated a good fit suggesting that this model of measurement offers an acceptable representation of the model. The final model (Figure 1) demonstrates no direct path between childhood emotional abuse and BPD; however, this relationship is confirmed through a non-direct path. In other words, both attachment styles and also difficulties in emotion regulation have fully-mediated the relationship between childhood emotional abuse and BPD.

4. Discussion 
The current study aims to investigate the SEM analysis of the relationship between childhood emotional abuse and BPD with mediating roles of attachment styles as well as difficulties in emotion regulation in Iranian student samples. Findings of the current study show that attachment styles and difficulties in emotion regulation can fully mediate the relationship between childhood emotional abuse and BPD, which are consistent with the findings of Kuo et al. [3], Neumann [15] and Critchfield et al. [16]. Furthermore, our model was statistically confirmed and is also consistent with Kuo et al. [42]. The only exception is that Kuo model suggests that difficulties in emotion regulation can partially mediate the relationship between childhood emotional abuse and BPD, but our model suggests complete mediation between these variables. According to our model, insecure anxious attachment can solely predict BPD along with experiencing emotional abuse in childhood. Also, difficulties in emotion regulation can predict BPD.
The child after being continually exposed to emotional abuse goes through developmental trajectories and pathways which make the child prone to BPD [18]. Two developmentally important pathways are attachment-based relationships and the development of emotion regulations. Current research shows that participants who had difficulties in this domains were more likely to have BPD features.
Ethical Considerations
Compliance with ethical guidelines

First, the general explanations of the research objectives were given to the participants and after receiving informed consent from them, test questions were distributed among them.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
All authors declared no conflict of interest. 
Acknowledgements 
We would like to specially acknowledge Dr. Mohsen Moradi for statistical consultations. Also, we acknowledge the participants of this research.

 
  1. Kaplan BJ. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2016.
  2. Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in borderline personality disorder: A meta-analysis. Nordic Journal of Psy-chiatry. 2005; 59(5):319-24. [DOI:10.1080/08039480500320025] [PMID]
  3. Apfelbaum S, Regalado P, Herman L, Teitelbaum J, Gagliesi P. Comorbidity between bipolar disorder and cluster B personality disorders as indicator of affective dysregulation and clinical severity. Actas Espanolas de Psiquiatria. 2013; 41(5):269-78. [PMID]
  4. Kuo JR, Khoury JE, Metcalfe R, Fitzpatrick S, Goodwill A. An examination of the relationship between childhood emotional abuse and borderline personality disorder features: The role of difficulties with emotion regulation. Child Abuse & Neglect. 2015; 39:147-55. [DOI:10.1016/j.chiabu.2014.08.008] [PMID]
  5. Zanarini MC, Yong L, Frankenburg FR, Hennen J, Reich DB, Marino MF, et al. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. The Journal of Nervous and Mental Disease. 2002; 190(6):381-7. [DOI:10.1097/00005053-200206000-00006] [PMID]
  6. Alilou MM, Hashemi T, Beirami M, Bakhshipour A, Sharifi MA. [Investigating the relationship between childhood maltreatment, loss and initial separation and emotional dysregulation with borderline personality disorder (Persian)]. Journal of Psychology Achievements. 2014; 21(2):65-88.
  7. Laporte L, Paris J, Guttman H, Russell J, Correa JA. Using a sibling design to compare childhood adversities in female patients with BPD and their sisters. Child Maltreatment. 2012; 17(4):318-29. [DOI:10.1177/1077559512461173] [PMID]
  8. Trickett PK, Mennen FE, Kim K, Sang J. Emotional abuse in a sample of multiply maltreated, urban young adolescents: Issues of definition and identification. Child Abuse & Neglect. 2009; 33(1):27-35. [DOI:10.1016/j.chiabu.2008.12.003] [PMID] [PMCID]
  9. Van Dijke A, Ford JD, van Son M, Frank L, van der Hart O. Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychological Trauma: Theory, Research, Practice, and Policy. 2013; 5(3):217-24. [DOI:10.1037/a0027256]
  10. Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. The Lancet. 2004; 364(9432):453-61. [DOI:10.1016/S0140-6736(04)16770-6]
  11. Cassidy J, Phillip R. Handbook of attachment: Theory, research, and clinical application. New York: Guilford Press, 2016.
  12. Levy KN. The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology. 2005; 17(4):959-86. [DOI:10.1017/S0954579405050455] [PMID]
  13. Aaronson CJ, Bender DS, Skodol AE, Gunderson JG. Comparison of attachment styles in borderline personality disorder and obses-sive-compulsive personality disorder. Psychiatric Quarterly. 2006; 77(1):69-80. [DOI:10.1007/s11126-006-7962-x] [PMID]
  14. Levy KN, Johnson BN, Clouthier TL, Scala J, Temes CM. An attachment theoretical framework for personality disorders. Canadian Psychology/Psychologie Canadienne. 2015; 56(2):197-207. [DOI:10.1037/cap0000025]
  15. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and ini-tial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. 2004; 26(1):41-54. [DOI:10.1023/B:JOBA.0000007455.08539.94]
  16. Southam-Gerow MA, Kendall PC. Emotion regulation and understanding: Implications for child psychopathology and therapy. Clinical Psychology Review. 2002; 22(2):189-222. [DOI:10.1016/S0272-7358(01)00087-3]
  17. Burns EE, Jackson JL, Harding HG. Child maltreatment, emotion regulation, and posttraumatic stress: The impact of emotional abuse. Journal of Aggression, Maltreatment & Trauma. 2010; 19(8):801-19. [DOI:10.1080/10926771.2010.522947]
  18. IBM. IBM SPSS statistics for windows, version 22.0. Armonk, New York: IBM; 2013.
  19. Jöreskog KG, Sörbom D, du Toit S. LISREL 8: New statistical features. Portland: Scientific Software International; 2001. [PMID]
  20. Arbuckle JL. IBM SPSS Amos 19 user’s guide. Crawfordville, Florida: Amos Development Corporation; 2010.
  21. Kline R. Principles and practice of structural equation modeling. New York: Guilford Press; 2015.
  22. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening ver-sion of the Childhood Trauma Questionnaire. Child Abuse & Neglect. 2003; 27(2):169-90. [DOI:10.1016/S0145-2134(02)00541-0]
  23. Mikaeili N, Zamanloo K. [A study of the prevalence of child abuse and its prediction from parents’ depression and anxiety, attach-ment styles and mental health of their adolescent boys (Persian)]. Psychology of Exceptional Individuals. 2012; 2(5):145-66.
  24. Mohammadzadeh A. [Validation of the borderline personality inventory in Iran (Persian)]. International Journal of Behavioral Scienc-es. 2009; 5(3):13-24.
  25. Narimani M, Abbasi M, Abolghasemi A, Ahadi B. [A study comparing the effectiveness of acceptance/ commitment by emotional regulation training on adjustment in students with dyscalculia (Persian)]. Learning Disabilities. 2013; 2(4):154-76.
  26. Pakdaman S. [A Study on the Relationship between Attachment Styles and Socialization in Adolescence (Persian)] [PhD thesis]. Tehran: University of Tehran; 2003.
  27. Chou CP, Bentler PM. Estimates and tests in structural equation modeling. In: Hoyle RH, editor. Structural Equation Modeling: Concepts, Issues, and Applications. Thousand Oaks, California: SAGE; 1995.
  28. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struc-tural Equation Modeling: A Multidisciplinary Journal. 1999; 6(1):1–55. [DOI:10.1080/10705519909540118]
  29. Westbrook J, Berenbaum H. Emotional awareness moderates the relationship between childhood abuse and borderline personality disorder symptom factors. Journal of Clinical Psychology. 2017; 73(7):910-21. [DOI:10.1002/jclp.22389] [PMID]
  30. Iwaniec D. The emotionally abused and neglected child: Identification, assessment and intervention: A practice handbook. Hoboken, New Jersey: John Wiley & Sons; 2006.
  31. Kim J, Cicchetti D. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry. 2010; 51(6):706-16. [DOI:10.1111/j.1469-7610.2009.02202.x] [PMID] [PMCID]
  32. Winsper C, Hall J, Strauss VY, Wolke D. Aetiological pathways to Borderline Personality Disorder symptoms in early adolescence: childhood dysregulated behaviour, maladaptive parenting and bully victimisation. Borderline Personality Disorder and Emotion Dysregulation. 2017; 4(1):10. [DOI:10.1186/s40479-017-0060-x] [PMID] [PMCID]
  33. Neumann E. Emotional abuse in childhood and attachment anxiety in adult romantic relationships as predictors of personality dis-orders. Journal of Aggression, Maltreatment & Trauma. 2017; 26(4):430-43. [DOI:10.1080/10926771.2017.1299826]
  34. Critchfield KL, Levy KN, Clarkin JF, Kernberg OF. The relational context of aggression in borderline personality disorder: Using adult attachment style to predict forms of hostility. Journal of Clinical Psychology. 2008; 64(1):67-82. [DOI:10.1002/jclp.20434] [PMID]
  35. Aghayousefi A, Saravani S, Zeraatee R, Razeghi FS, Pourabdol S. [Prediction of students’ academic performance based on attach-ment styles and different levels of adjustment (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2016; 21(4):308-16.
  36. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology. 1987; 52(3):511. [DOI:10.1037/0022-3514.52.3.511] [PMID]
  37. Maughan A, Cicchetti D. Impact of child maltreatment and interadult violence on children’s emotion regulation abilities and socio-emotional adjustment. Child Development. 2002; 73(5):1525-42. [DOI:10.1111/1467-8624.00488] [PMID]
  38. Cicchetti D, Lynch M. Toward an ecological/transactional model of community violence and child maltreatment: Consequences for children’s development. Psychiatry. 1993; 56(1):96-118. [DOI:10.1080/00332747.1993.11024624] [PMID]
  39. Conklin CZ, Bradley R, Westen D. Affect regulation in borderline personality disorder. The Journal of Nervous and Mental Disease. 2006; 194(2):69-77. [DOI:10.1097/01.nmd.0000198138.41709.4f] [PMID]
  40. Bierer LM, Yehuda R, Schmeidler J, Mitropoulou V, New AS, Silverman JM, et al. Abuse and neglect in childhood: Relationship to per-sonality disorder diagnoses. CNS Spectrums. 2003; 8(10):737-54. [DOI:10.1017/S1092852900019118] [PMID]
  41. Kuo JR, Linehan MM. Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology. 2009; 118(3):531-44. [DOI:10.1037/a0016392] [PMID] [PMCID]
  42. Kuo JR, Fitzpatrick S, Metcalfe RK, McMain S. A multi-method laboratory investigation of emotional reactivity and emotion regulation abilities in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry. 2016; 50:52-60. [DOI:10.1016/j.jbtep.2015.05.002] [PMID]
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2018/02/7 | Accepted: 2018/05/9 | Published: 2018/07/24

References
1. Kaplan BJ. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2016.
2. Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in borderline personality disorder: A meta-analysis. Nordic Journal of Psy-chiatry. 2005; 59(5):319-24. [DOI:10.1080/08039480500320025] [PMID] [DOI:10.1080/08039480500320025]
3. Apfelbaum S, Regalado P, Herman L, Teitelbaum J, Gagliesi P. Comorbidity between bipolar disorder and cluster B personality disorders as indicator of affective dysregulation and clinical severity. Actas Espanolas de Psiquiatria. 2013; 41(5):269-78. [PMID] [PMID]
4. Kuo JR, Khoury JE, Metcalfe R, Fitzpatrick S, Goodwill A. An examination of the relationship between childhood emotional abuse and borderline personality disorder features: The role of difficulties with emotion regulation. Child Abuse & Neglect. 2015; 39:147-55. [DOI:10.1016/j.chiabu.2014.08.008] [PMID] [DOI:10.1016/j.chiabu.2014.08.008]
5. Zanarini MC, Yong L, Frankenburg FR, Hennen J, Reich DB, Marino MF, et al. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. The Journal of Nervous and Mental Disease. 2002; 190(6):381-7. [DOI:10.1097/00005053-200206000-00006] [PMID] [DOI:10.1097/00005053-200206000-00006]
6. Alilou MM, Hashemi T, Beirami M, Bakhshipour A, Sharifi MA. [Investigating the relationship between childhood maltreatment, loss and initial separation and emotional dysregulation with borderline personality disorder (Persian)]. Journal of Psychology Achievements. 2014; 21(2):65-88.
7. Laporte L, Paris J, Guttman H, Russell J, Correa JA. Using a sibling design to compare childhood adversities in female patients with BPD and their sisters. Child Maltreatment. 2012; 17(4):318-29. [DOI:10.1177/1077559512461173] [PMID] [DOI:10.1177/1077559512461173]
8. Trickett PK, Mennen FE, Kim K, Sang J. Emotional abuse in a sample of multiply maltreated, urban young adolescents: Issues of definition and identification. Child Abuse & Neglect. 2009; 33(1):27-35. [DOI:10.1016/j.chiabu.2008.12.003] [PMID] [PMCID] [DOI:10.1016/j.chiabu.2008.12.003]
9. Van Dijke A, Ford JD, van Son M, Frank L, van der Hart O. Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychological Trauma: Theory, Research, Practice, and Policy. 2013; 5(3):217-24. [DOI:10.1037/a0027256] [DOI:10.1037/a0027256]
10. Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. The Lancet. 2004; 364(9432):453-61. [DOI:10.1016/S0140-6736(04)16770-6] [DOI:10.1016/S0140-6736(04)16770-6]
11. Cassidy J, Phillip R. Handbook of attachment: Theory, research, and clinical application. New York: Guilford Press, 2016.
12. Levy KN. The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology. 2005; 17(4):959-86. [DOI:10.1017/S0954579405050455] [PMID] [DOI:10.1017/S0954579405050455]
13. Aaronson CJ, Bender DS, Skodol AE, Gunderson JG. Comparison of attachment styles in borderline personality disorder and obses-sive-compulsive personality disorder. Psychiatric Quarterly. 2006; 77(1):69-80. [DOI:10.1007/s11126-006-7962-x] [PMID] [DOI:10.1007/s11126-006-7962-x]
14. Levy KN, Johnson BN, Clouthier TL, Scala J, Temes CM. An attachment theoretical framework for personality disorders. Canadian Psychology/Psychologie Canadienne. 2015; 56(2):197-207. [DOI:10.1037/cap0000025] [DOI:10.1037/cap0000025]
15. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and ini-tial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. 2004; 26(1):41-54. [DOI:10.1023/B:JOBA.0000007455.08539.94] [DOI:10.1023/B:JOBA.0000007455.08539.94]
16. Southam-Gerow MA, Kendall PC. Emotion regulation and understanding: Implications for child psychopathology and therapy. Clinical Psychology Review. 2002; 22(2):189-222. [DOI:10.1016/S0272-7358(01)00087-3] [DOI:10.1016/S0272-7358(01)00087-3]
17. Burns EE, Jackson JL, Harding HG. Child maltreatment, emotion regulation, and posttraumatic stress: The impact of emotional abuse. Journal of Aggression, Maltreatment & Trauma. 2010; 19(8):801-19. [DOI:10.1080/10926771.2010.522947] [DOI:10.1080/10926771.2010.522947]
18. IBM. IBM SPSS statistics for windows, version 22.0. Armonk, New York: IBM; 2013.
19. Jöreskog KG, Sörbom D, du Toit S. LISREL 8: New statistical features. Portland: Scientific Software International; 2001. [PMID] [PMID]
20. Arbuckle JL. IBM SPSS Amos 19 user's guide. Crawfordville, Florida: Amos Development Corporation; 2010.
21. Kline R. Principles and practice of structural equation modeling. New York: Guilford Press; 2015.
22. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening ver-sion of the Childhood Trauma Questionnaire. Child Abuse & Neglect. 2003; 27(2):169-90. [DOI:10.1016/S0145-2134(02)00541-0] [DOI:10.1016/S0145-2134(02)00541-0]
23. Mikaeili N, Zamanloo K. [A study of the prevalence of child abuse and its prediction from parents' depression and anxiety, attach-ment styles and mental health of their adolescent boys (Persian)]. Psychology of Exceptional Individuals. 2012; 2(5):145-66.
24. Mohammadzadeh A. [Validation of the borderline personality inventory in Iran (Persian)]. International Journal of Behavioral Scienc-es. 2009; 5(3):13-24.
25. Narimani M, Abbasi M, Abolghasemi A, Ahadi B. [A study comparing the effectiveness of acceptance/ commitment by emotional regulation training on adjustment in students with dyscalculia (Persian)]. Learning Disabilities. 2013; 2(4):154-76.
26. Pakdaman S. [A Study on the Relationship between Attachment Styles and Socialization in Adolescence (Persian)] [PhD thesis]. Tehran: University of Tehran; 2003.
27. Chou CP, Bentler PM. Estimates and tests in structural equation modeling. In: Hoyle RH, editor. Structural Equation Modeling: Concepts, Issues, and Applications. Thousand Oaks, California: SAGE; 1995.
28. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struc-tural Equation Modeling: A Multidisciplinary Journal. 1999; 6(1):1–55. [DOI:10.1080/10705519909540118] [DOI:10.1080/10705519909540118]
29. Westbrook J, Berenbaum H. Emotional awareness moderates the relationship between childhood abuse and borderline personality disorder symptom factors. Journal of Clinical Psychology. 2017; 73(7):910-21. [DOI:10.1002/jclp.22389] [PMID] [DOI:10.1002/jclp.22389]
30. Iwaniec D. The emotionally abused and neglected child: Identification, assessment and intervention: A practice handbook. Hoboken, New Jersey: John Wiley & Sons; 2006.
31. Kim J, Cicchetti D. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry. 2010; 51(6):706-16. [DOI:10.1111/j.1469-7610.2009.02202.x] [PMID] [PMCID] [DOI:10.1111/j.1469-7610.2009.02202.x]
32. Winsper C, Hall J, Strauss VY, Wolke D. Aetiological pathways to Borderline Personality Disorder symptoms in early adolescence: childhood dysregulated behaviour, maladaptive parenting and bully victimisation. Borderline Personality Disorder and Emotion Dysregulation. 2017; 4(1):10. [DOI:10.1186/s40479-017-0060-x] [PMID] [PMCID] [DOI:10.1186/s40479-017-0060-x]
33. Neumann E. Emotional abuse in childhood and attachment anxiety in adult romantic relationships as predictors of personality dis-orders. Journal of Aggression, Maltreatment & Trauma. 2017; 26(4):430-43. [DOI:10.1080/10926771.2017.1299826] [DOI:10.1080/10926771.2017.1299826]
34. Critchfield KL, Levy KN, Clarkin JF, Kernberg OF. The relational context of aggression in borderline personality disorder: Using adult attachment style to predict forms of hostility. Journal of Clinical Psychology. 2008; 64(1):67-82. [DOI:10.1002/jclp.20434] [PMID] [DOI:10.1002/jclp.20434]
35. Aghayousefi A, Saravani S, Zeraatee R, Razeghi FS, Pourabdol S. [Prediction of students' academic performance based on attach-ment styles and different levels of adjustment (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2016; 21(4):308-16.
36. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology. 1987; 52(3):511. [DOI:10.1037/0022-3514.52.3.511] [PMID] [DOI:10.1037/0022-3514.52.3.511]
37. Maughan A, Cicchetti D. Impact of child maltreatment and interadult violence on children's emotion regulation abilities and socio-emotional adjustment. Child Development. 2002; 73(5):1525-42. [DOI:10.1111/1467-8624.00488] [PMID] [DOI:10.1111/1467-8624.00488]
38. Cicchetti D, Lynch M. Toward an ecological/transactional model of community violence and child maltreatment: Consequences for children's development. Psychiatry. 1993; 56(1):96-118. [DOI:10.1080/00332747.1993.11024624] [PMID] [DOI:10.1080/00332747.1993.11024624]
39. Conklin CZ, Bradley R, Westen D. Affect regulation in borderline personality disorder. The Journal of Nervous and Mental Disease. 2006; 194(2):69-77. [DOI:10.1097/01.nmd.0000198138.41709.4f] [PMID] [DOI:10.1097/01.nmd.0000198138.41709.4f]
40. Bierer LM, Yehuda R, Schmeidler J, Mitropoulou V, New AS, Silverman JM, et al. Abuse and neglect in childhood: Relationship to per-sonality disorder diagnoses. CNS Spectrums. 2003; 8(10):737-54. [DOI:10.1017/S1092852900019118] [PMID] [DOI:10.1017/S1092852900019118]
41. Kuo JR, Linehan MM. Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology. 2009; 118(3):531-44. [DOI:10.1037/a0016392] [PMID] [PMCID] [DOI:10.1037/a0016392]
42. Kuo JR, Fitzpatrick S, Metcalfe RK, McMain S. A multi-method laboratory investigation of emotional reactivity and emotion regulation abilities in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry. 2016; 50:52-60. [DOI:10.1016/j.jbtep.2015.05.002] [PMID] [DOI:10.1016/j.jbtep.2015.05.002]

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